title: The "H" graft: an alternative approach for performing minimally invasive direct coronary artery bypass.
abstract: OBJECTIVE
  Minimally invasive direct coronary artery bypass permits arterial revascularization without cardiopulmonary bypass, potentially decreasing associated morbidity. The procedure is, however, technically challenging and associated with significant postoperative pain resulting from retraction through the small incision. METHODS AND PATIENT SELECTION: From December 1996 to April 1997, eight patients underwent grafting of the left anterior descending coronary artery by use of a short segment of right inferior epigastric artery attached proximally to the side of an in situ left internal thoracic artery. We have termed this procedure the "H" graft MIDCAB.
  
  
  RESULTS
  No patients required intraoperative conversion to conventional bypass. No postoperative deaths or myocardial infarctions occurred. Six patients with normal renal function underwent postoperative angiography that demonstrated graft patency with rapid filling of the left anterior descending coronary in each case. Postoperatively clinical signs of acute ischemia were resolved or a normal exercise tolerance test was obtained in all patients. The median postoperative length of stay was 3 days. Rib spreading and chest wall retraction were not required in any procedure.
  
  
  CONCLUSIONS
  The "H" graft procedure is an attractive alternative to standard minimally invasive bypass because of greater technical simplicity, the avoidance of internal thoracic artery harvest, and excellent visualization with no chest wall retraction.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. 02215, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Cohn
authors.forename: H C
authors.initials: HC
authors.lastname: Suen
authors.forename: R M
authors.initials: RM
authors.lastname: Weintraub
authors.forename: R G
authors.initials: RG
authors.lastname: Johnson
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D019074:Epigastric Arteries / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures